| NAMED DRIVER
EXCLUSION ENDORSEMENT | |
| Voiding Automobile Insurance While a Named Person is operating a Covered Automobile |
| This Endorsement forms a part of Policy Number:
_____________________________________________ Issued to: _______________________________________________________________________________ By the Company at its Agency located at: ____________________________________________________ |
| The premium for this policy and our continuing this policy in force is based on your telling us that the person named below will not operate or use a covered auto. Therefore, this policy is changed by adding the following exclusion: |
| This insurance does not apply to damages, accidents, or losses caused while a covered auto is being operated or used by _____________________________________ whether or not you have given your express or implied permission for this operation or use. |
| All other terms of this policy remain unchanged. |
| This endorsement takes effect at 12:01 a.m. Standard Time on the date indicated below. |
| The Named Insured (or Authorized Representative) accepts this endorsement as witnessed by his/her signature signifying agreement. |
| _____________________________________________________________ | ____________________________________ | |
| Excluded Operator's Signature | Date | |
| _____________________________________________________________ | ____________________________________ | |
| Named Insured / Authorized Signature | Effective Date of Endorsement | |
| _____________________________________________________________ | ____________________________________ | |
| Signature of Agent | Date | |
| MK2003 (10/97) | ||